29th Jul 2014
Contraceptive use varies by age and culture. Here is an update on women’s choices in Australia.
TWO-thirds of Australian women of reproductive age report currently using contraception.
The recently published Reproductive and Sexual Health in Australia report 1highlights that oral contraception remains the most common method (up to 34%), followed by condoms (23%), vasectomy (11%) and tubal ligation (8.6%).
By contrast, the least used are intrauterine methods (3%) and the contraceptive implant (3%). Withdrawal is reported by 2.4% of women and the proportion reporting they had ever used emergency contraception is 27%.
While limitations to the data are acknowledged, it is notable that Australia lags behind similar high-income countries in the uptake of long-acting reversible contraception (LARC).
This is an effective and safe choice for women across the reproductive life course, including young nulliparous women.
LARC, including contraceptive implants, intrauterine devices (IUDs) and the contraceptive injection, provides highly effective contraception and does not require user input.
Despite these proven benefits, LARC uptake remains low with barriers existing at the level of the healthcare system, providers and the community. Lack of awareness, misinformation, concerns about side effects, lack of access to trained providers and relatively high upfront costs may contribute to the low uptake.
Increasing uptake of LARC has been identified as a public health priority to decrease unintended pregnancy and abortion in many countries, including the UK and the US.
Contraceptive use by age group
Contraceptive use increases from teenage years into the 20s and declines at ages 30—35 years prior to another increase. The dip most likely reflects a desire to conceive given that the average maternal age in Australia is 30 years.
Young women, who have the highest fertility, tend to use the least effective contraceptive methods, including condoms and oral contraception, while women approaching menopause have a higher uptake of intrauterine and permanent methods.
While evidence points to insufficient awareness of age-related infertility, an underestimation of fertility may also contribute to unintended pregnancy in women in their 40s. LARC will likely replace permanent methods for this group in the future.
Dual protection
Condoms are highly effective at preventing STIs but have a high failure rate in preventing unintended pregnancy. Promoting dual use of condoms and other effective methods of contraception is important for women of all ages who are at risk of contracting an STI.
Emergency contraception
Despite increased accessibility to the emergency contraception pill (ECP), there has not been a reduction in unintended pregnancy or abortion rates.
This failure may be attributable to lack of knowledge that ECP is available without a prescription and that its effectiveness extends beyond 24 hours to up to 96 hours after unprotected intercourse.
Improved access to the copper IUD, which provides highly effective post-coital contraception and can be continued in the long term, is likely to have an impact on reproductive health outcomes.
Contraceptive use in Aboriginal communities
Contraceptive use among Aboriginal women is lower than among non-Aboriginal women (64% vs 71% ), with higher rates of tubal ligation (14% vs 4.1%) and lower uptake of oral contraception (23% vs 35%).
Both the implant and injection are used more commonly by Aboriginal women (7% and 8% respectively) than the national average (less than 2% for both methods).
Lack of access to culturally sensitive services, transport and affordability as well as a positive attitude to pregnancy at a young age have been identified as factors limiting contraceptive uptake.
Contraceptive use among women from non-English speaking backgrounds
Contraceptive use among this group of women is much lower than among women from Australia or other English-speaking countries (50% vs 71%), which is likely to be related to sociocultural factors in relation to family size as well as issues of access to culturally and linguistically appropriate information and services, and affordability.
Practice Points
- Australia has relatively low LARC uptake despite proven advantages of it.
- Dual protection against unintended pregnancy and STIs can be achieved through the use of condoms and an effective contraceptive method.
- Knowledge that emergency contraception can be obtained without a doctor’s visit and is effective up to 96 hours after unprotected intercourse remains low.
- Older women need evidence-based information, both in relation to declining fertility and the chance of a successful pregnancy through ART, and the need for contraception to prevent unintended pregnancy.
- The lower uptake of contraception by Aboriginal women and by women from non-English speaking countries is likely to be related to sociocultural factors, access barriers and affordability.
References
1. Family Planning NSW. Reproductive and sexual health in Australia. Ashfield, Sydney: 2013; http://www.fpnsw.org.au/688423_21_13559012.html
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